Soft Robotic Exosuit Helps Stroke Survivors Rehabilitate

Unless it addresses these other problems, it is going to be limited in use. But will it prevent ankle rolling or straighten the foot so it points directly forward, from spasticity angling the foot outward?  

Is this better than the Anklebot? WHOM is going to do the research that proves the best 100% recovery for walking? We need a specific person assigned. WHOM IS IT?

This is compensation, did it improve actual recovery?

• Anklebot (5)

 

Soft Robotic Exosuit Helps Stroke Survivors Rehabilitate

A new soft ankle wearable can potentially combat hemiparesis in stroke survivors.

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The soft robotic exosuit is worn by stroke patients on the hemiparetic side of their bodies. (Image courtesy of Harvard John A. Paulson School of Engineering and Applied Sciences.)

A new soft robotic exosuit could potentially assist individuals recovering from stroke. An ankle-assisting wearable connected to an external battery and motor was used in the initial stages to support rehabilitating stroke patients while they performed on a treadmill. The biomechanical gait function of patients significantly improved just from using the device. The research team recently moved to the next stage by working toward a rehabilitation-focused strategy and created an untethered version of the device.
The new device carries its own battery and motor, making it mobile for stroke patients even outside of physical therapy settings. It weighs less than five kilograms and is powered by a battery and is initiated by an actuator unit that can be worn at the hips. The device targets the limbs during phases of the gait cycle and delivers mechanical power to the ankles through a cable-based system that is attached to the patient’s body. Instead of using rigid materials, the exosuit uses lightweight functional textiles.

The team from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), Wyss Institute for Biologically Inspired Engineering, and Boston University’s College of Health & Rehabilitation Sciences, Sargent College specifically designed the exosuit to assist with plantar flexion—the ankle movement that pushes the foot down toward the ground during the stance phase of the gait cycle. The device also helps with dorsiflexion—the action when the foot is lifted up and the toes are pulled toward the shin during the swing phase of the gait cycle.
This soft robotic exosuit can potentially address the hemiparetic walking and “drop foot” typically associated with stroke survivors. The device was tested on six hemiparetic individuals with distinct severities and impairments who were asked to perform a series of activities on a 30-meter walkway. According to the report, the researchers observed “important and immediate improvements in walking speed and distance.”
The team expressed their optimism for the future of the technology.
“Our engineering and clinical teams at Harvard and Boston University are highly motivated by these results to refine the technology and study its immediate impact(What about long term recovery? Can you walk out of it and successfully walk without it? How long does that take?) in stroke survivors with a wide range of walking abilities. We are also eager to explore therapeutic applications in both clinical settings and day-to-day walking in the home and community,” said Lou Awad of the Wyss Institute.
The complete findings can be found in the IEEE Open Journal of Engineering in Medicine and Biology (OJEMB).

Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke

Useless,because it didn't answer the only question in stroke. 'Did it work to recover back to a normal gait?'  I blame the mentors and senior researchers for incompetently not setting the correct objective for stroke studies.

 Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke

 Abstract

Background:
Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern. The purpose of this study was to assess the effects of the added mass of one of these robots, the MIT's Anklebot, while unpowered, on gait of chronic stroke survivors during overground and treadmill walking.
Methods:
Nine chronic stroke survivors walked overground and on a treadmill with and without the anklebot mounted on the paretic leg. Gait parameters, interlimb symmetry, and joint kinematics were collected for the four conditions. Repeated-measures analysis of variance (ANOVA) tests were conducted to examine for possible differences across four conditions for the paretic and nonparetic leg.
Results:
 The added inertia and friction of the unpowered anklebot had no statistically significant effect on spatio-temporal parameters of gait, including paretic and nonparetic step time and stance percentage, in both overground and treadmill conditions. Noteworthy, interlimb symmetry as characterized by relative stance duration was greater on the treadmill than overground regardless of loading conditions. The presence of the unpowered robot loading reduced the nonparetic knee peak flexion on the treadmill and paretic peak dorsiflexion overground (p < 0.05).
Conclusions:
Our results suggest that for these subjects the added inertia and friction of this backdriveable robot did not significantly alter their gait pattern.

Feinstein Institute study finds robotic ankle rehabilitation helps post stroke recovery

More research will be needed to compare this latest one to the earlier 3 posts on anklebots. But that won't occur because we have NO fucking stroke leadership and NO fucking stroke strategy.
We need a damned protocol on what survivors can use this and what exercises they need to do to recover complete ankle function. That is the goal, damn it all. Get there! 
http://www.prnewswire.com/news-releases/feinstein-institute-study-finds-robotic-ankle-rehabilitation-helps-post-stroke-recovery-300499220.html

Stroke patients with high function walking speed had potential to return to normal after rehabilitation

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News provided by

Feinstein Institute for Medical Research

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MANHASSET, N.Y., Aug. 3, 2017 /PRNewswire-USNewswire/ -- A study published in NeuroRehabilitation by Feinstein Institute for Medical Research scientist Bruce T. Volpe, MD and Johanna L. Chang found that isolated ankle training with a robotic therapy device can improve walking speed and balance after a stroke, depending on the severity of the patient's initial impairment. Better understanding of severity-dependent recovery profiles after stroke will help medical professionals determine the best candidates for robotic rehabilitation. 

Strokes happen when a patient's brain does not receive sufficient blood supply due to a blockage or rupture of a blood vessel, which can result in impairment of motor or cognitive function. Patients typically participate in rehabilitation programs that focus on specific enhanced motor activity of their limbs under the direction of physical and occupational therapists.
Robotic devices are effective tools to aid in this recovery of, for example, wrist and arm movement. The devices have been less effective in encouraging recovery of walking speed (also known as gait). Dr. Volpe's study examines whether a robotic-assist device that uses interactive ankle movement in a seated position would improve a patient's walking speed and balance.
"Exercise is one of the main ways for patients who have had a stroke to regain movement," said Ms. Chang, who is the lead author of the study. "The use of robotic assisted-devices can enhance the therapy by increasing the intensity of the motor experience. This interactive robotic device moves the paralyzed arm or leg when the patient cannot and gets out of the way when the patient powers the movement.  In our study, the baseline or initial walking speed prior to therapy was an important factor in predicting the final walking speed."
Twenty-nine study participants with a foot drop and walking speed abnormalities after stroke were treated three times a week for six weeks with robot-assisted ankle training. The patients were separated into three groups: high function (walking speed greater than 3 feet per second), medium function (1 foot per second) and low function (less than 1 foot per second). During a session, patients were seated in front of a video monitor and the ankle robot was attached at the knee and foot. The patient viewed the video screen that had a cursor and used their legs and ankle to move the cursor to reach a particular target.
After 18 sessions, the high and medium function groups demonstrated significant improvements in walking speed, with the high functioning group achieving a speed that is considered normal for ambulating patients in the community (greater than 4 feet per second).  A further exciting result showed that in follow-up three months after the treatment finished, the high function group continued to improve (4.39 feet per second). The low functioning group demonstrated the greatest change in improved balance.
"Much like one medication is not effective for all patients with a certain condition, not all rehabilitation is beneficial to all," said Kevin J. Tracey, MD, president and CEO of the Feinstein Institute. "By understanding who can most benefit from robotic rehabilitation medical professionals can better tailor a program that will result in the highest benefit for patients."
About the Feinstein InstituteThe Feinstein Institute for Medical Research is the research arm of Northwell Health, the largest healthcare provider in New York. Home to 50 research laboratories and to clinical research throughout dozens of hospitals and outpatient facilities, the Feinstein includes 4,000  researchers and staff who are making breakthroughs in molecular medicine, genetics, oncology, brain research, mental health, autoimmunity, and bioelectronic medicine – a new field of science that has the potential to revolutionize medicine. For more information about how we empower imagination and pioneer discovery, visit FeinsteinInstitute.org
Contact: Heather E. Ball 
516-465-7917
hball@northwell.edu

SOURCE Feinstein Institute for Medical Research

Japanese robo boot could help stroke sufferers walk again

Does your doctor and physical therapist know about this? How does it compare to the Anklebot?

http://www.bitterwallet.com/japanese-robo-boot-could-help-stroke-sufferers-walk-again/68816

We all love a Japanese robo boot, and Yaskawa Electric have given us a doozy – a motorised leg brace which has been designed to give stroke patients the confidence to walk again.

Catchily named the Ankle Walking Assist Device, the robot boot was developed by the Shibaura Institute of Technology and Hiroshima University’s Space Bio Laboratories –and marks an exciting new wave in robotic mobility devices that beat wheelchairs, crutches and motorised scooters hands down.
The boot fits around the leg and foot with Velcro straps and the motor connects to a battery pack around the waist. When the heel hits the ground, the robo-boot sends a boost to the foot to keep up the walking pace.
In a bid to address the problems of Japan’s ageing population, assistive robotics is a big industry, with the world’s first neuroprosthetic robot suit also certified for production this year.
So, soon we could see old people in Britain walking around in Iron Man robot suits and going to the shops on TURBO. And when she finally gets that new exoskeleton, you’re not going to see your Gran for dust.

Clinical application of a modular ankle robot for stroke rehabilitation

Sounds interesting that they are working on chronic. I'm impressed in those that don't take the easy way out and do studies during spontaneous recovery. See what your therapist thinks of this.
http://iospress.metapress.com/content/v82m87h5502486k5/

Abstract

BACKGROUND: Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait.

OBJECTIVES: Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance.

METHODS: An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response.

RESULTS: Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training.

CONCLUSIONS: Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance.

Ankle robots help participants retrain gait in study at the Maryland VA

And its even for chronic.
http://articles.baltimoresun.com/2013-06-02/health/bs-hs-anklebots-20130602_1_stroke-survivors-ischemic-stroke-national-stroke-association

One night in 1999, a rash of frightening sensations hit Paul Titus all at once.
His left arm went numb. His left eye began twitching. He couldn't speak without slurring.
Unaware what the symptoms meant, he was slow to call for help. When his ischemic stroke was finally over, he was paralyzed on his left side and for 14 years he needed a leg brace and cane just to stay upright.

One morning last week, Titus smiled as he loped along on a treadmill in a makeshift gym. A high-tech, brace-like device wrapped his left ankle, monitoring his gait 200 times per second and supplying energy boosts as needed.
"I think I'm [finally] getting close to getting rid of my cane," he said, huffing as he went.
Titus, 47, of Middle River, is a participant in a two-year Veterans Health Administration study of the ankle machine — an $80,000 rehabilitative robot known as the Anklebot — and of how much it helps stroke survivors improve their gait even years after a disabling attack.
"It's too early to draw scientific conclusions, but, anecdotally, many participants are saying [the Anklebot] is a big help," said Larry Forrester, a rehabilitation scientist with the VA Maryland Health Care System and associate professor at the University of Maryland School of Medicine.
Forrester and Anindo Roy, a robotics engineer with the Baltimore Veterans Affairs Medical Center, are co-directors of the study, which will compare how participants fare while wearing the Anklebot on a treadmill with others who wear it in a seated position as they operate a foot-controlled video game.
A $199,000 pilot grant from the Veterans Health Administration is funding the project, which is scheduled to last through next summer. Twenty volunteers have taken part so far.
According to the National Stroke Association, a stroke occurs when a clot or rupture cuts off blood flow to the brain. This causes the death of cells in the brain. If the region happens to control a particular body function, that function can be permanently damaged.
Until about 20 years ago, according to Forrester, conventional wisdom in medical science held that stroke survivors who have persistent disabilities have about six months in which to improve. After that, the brain's neural pathways were thought to be more or less permanently re-established, and the best stroke survivors could hope for was to use exercise to maintain good overall health.
"Rehabilitation didn't fix you," Forrester said.
Starting in the early 1990s, though, researchers across several disciplines began to realize that exercise and other external changes could restore damaged connections and even generate new ones.
That included research teams at the Baltimore VA, where Forrester and a mentor, University of Maryland neurologist Richard Macko, proved during the early 2000s that stroke survivors who worked out on treadmills saw increased neural as well as motor improvement, each side apparently reinforcing the other.
This realization — that the brain is "plastic," not static — opened "huge new vistas," Roy said, for those in the rehabilitation sciences.